Epidemiology of Stroke in Blacks in Africa

I reviewed the literature on epidemiology of Stroke in Blacks in Africa. Stroke, said to be rare in Black Africans some four decades ago, has become increasingly common now accounting for 4% to 9% of deaths and 6.5% to 41% of neurological admissions in hospital populations. In community-based studies, it is the third or fourth commonest non-infective neurological disease, after headache, epilepsy and diseases of peripheral nerves. In both hospitals and communities, males are more afflicted than females. The age specific incidence rates are similar to those found in Caucasians and Japanese. Occlusive stroke is the commonest type accounting for about 60%, followed by cerebral haemorrhage (20%) subarachnoid haemorrhage (10%). The major risk factor is hypertension which is present in 80% or more in patients with cerebral haemorrhage and subarachnoid haemorrhage, and in 60% in those with occlusive stroke. Other risk factors are age, sickle cell disease, diabetes mellitus, non-ischaemic heart disease (including cardiomyopathies, infective endocarditis, atrial fibrillation mitral valve prolapse) infections, arteritis, smoking, alcohol consumption and cocaine use (in the young people), Transient ischaemic attracts are relatively uncommon reflecting the rarity of large vessel atherosclerotic disease. Case fatality rate is higher than in the developed countries. About 15% of young people (below age of 40 years) with stroke have no identifiable risk factor. Studies are needed on the effectiveness of population-based control of hypertension (which afflicts 10% to 30% of African communities) to reduce the incidence of stroke, especially as atherosclerotic ischaemic heart disease, although emerging is still relatively uncommon in Sub-Saharan African communities. (Hypertens Res 1994; 17 Suppl. I: S1-S10)